肝包虫囊肿治疗的系统评价与荟萃分析：腹腔镜手术与开放手术的比较

A systematic review and meta-analysis on the treatment of liver hydatid cyst: Comparing laparoscopic and open surgeries.

作者信息

Sokouti Massoud, Sadeghi Ramin, Pashazadeh Saeid, Abadi Saeed Eslami Hasan, Sokouti Mohsen, Rezaei-Hachesu Peyman, Ghojazadeh Morteza, Sokouti Babak

机构信息

Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

出版信息

Arab J Gastroenterol. 2017 Sep;18(3):127-135. doi: 10.1016/j.ajg.2017.09.010. Epub 2017 Oct 4.

DOI:10.1016/j.ajg.2017.09.010

PMID:28988788

Abstract

BACKGROUND AND STUDY AIMS

There is an academic debate regarding surgical interventions for liver hydatid cyst disease. The purpose of the current systematic review and meta-analysis study was to analyse the pros and cons of open surgery and laparoscopic techniques, considering the outcomes of liver hydatid cysts.

METHODS

Descriptive Boolean queries were used to search PubMed and Scopus for articles published between January 2000 and December 2016 to evaluate the outcomes of liver hydatid cyst in terms of mortality, post-operative complications, cure rate and recurrences. The data related to the four outcomes of liver hydatid cyst were extracted, assessed and then used as their corresponding effect sizes in the meta-analysis process.

RESULTS

Six studies totally consisting of 1028 patients [open surgery group=816 (+7 converted to lap) and laparoscopic group=212] were analysed. In this meta-analysis study, random effects models of outcomes (i.e. post-operative complications, mortalities, recurrences and cure rate) of the two procedures were OR=0.852, LL=0.469, UL=1.546, Z=-0.526, p=0.599 (for post-operative complications); OR=0.849, LL=0.141, UL=5.105, Z=-0.179, p=0.858 (for mortality); OR=0.903, LL=0.166, UL=4.906, Z=-0.119, p=0.906 (for recurrence); and OR=0.459, LL=0.129, UL=1.637, Z=-1.201, p=0.230 (for cure rate). Meta-analysis and illustrated forest plots showed that there are no superiorities between the two approaches. The results of heterogeneity tests of the above mentioned outcomes were Q=8.083, df=5, p=0.152, I=38.142% for post-operative complications; Q=0.127, df=2, p=0.938, I=0% for mortality; Q=4.984, df=2, p=0.083, I=59.874% for recurrence; and Q=10.639, df=5, p=0.059, I=53.001% for cure rate. The results of regression tests based on Egger's, smoothed variance based on Egger (SVE) and smoothed variance based on Thomson (SVT) showed that the p values are not significant, and there are neither significant statistical differences nor publication bias between the outcomes of the two treatment procedures.

CONCLUSION

The results show no promising trends towards advantages of open versus laparoscopic surgeries in the treatment of liver hydatid cyst. However, informative measurement values for comparing these surgeries could be derived for complications, recurrence, mortality and cure rates. Furthermore, all three tests, namely Egger's, SVE and SVT regression models, were used to assess publication bias and showed no evidence for the existence of publication bias.

摘要

背景与研究目的

关于肝包虫囊肿病的手术干预存在学术争论。本系统评价和荟萃分析研究的目的是，考虑肝包虫囊肿的治疗结果，分析开放手术和腹腔镜技术的利弊。

方法

使用描述性布尔查询在PubMed和Scopus中检索2000年1月至2016年12月发表的文章，以评估肝包虫囊肿在死亡率、术后并发症、治愈率和复发率方面的治疗结果。提取、评估与肝包虫囊肿这四项治疗结果相关的数据，然后在荟萃分析过程中用作相应的效应量。

结果

共分析了6项研究，总计1028例患者[开放手术组=816例（7例转为腹腔镜手术），腹腔镜组=212例]。在这项荟萃分析研究中，两种手术方式的各项治疗结果（即术后并发症、死亡率、复发率和治愈率）的随机效应模型分别为：术后并发症：OR=0.852，下限=0.469，上限=1.546，Z=-0.526，p=0.599；死亡率：OR=0.849，下限=0.141，上限=5.105，Z=-0.179，p=0.858；复发率：OR=0.903，下限=0.166，上限=4.906，Z=-0.119，p=0.906；治愈率：OR=0.459，下限=0.129，上限=1.637，Z=-1.201，p=0.230。荟萃分析和森林图显示，两种手术方式之间没有优势差异。上述治疗结果的异质性检验结果分别为：术后并发症：Q=8.083，自由度=5，p=0.152，I²=38.142%；死亡率：Q=0.127，自由度=2，p=0.938，I²=0%；复发率：Q=4.984，自由度=2，p=0.083，I²=59.874%；治愈率：Q=10.639，自由度=5，p=0.059，I²=53.001%。基于Egger法、基于Egger法的平滑方差（SVE）和基于Thomson法的平滑方差（SVT）的回归检验结果显示，p值不显著，两种治疗方式的治疗结果之间既无显著统计学差异，也不存在发表偏倚。